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MARION COUNTY BUILDING iNSPECTION IFOR"'OFFICE USE ONLY <br /> 220 High Strut NE[ City SetN~ek <br /> <br /> BUILDING PERMIT APPLI~/F~OA'N!o~, <br />C~)MPLETE <br /> c <br />1. Job D~riptlon <br /> <br />2. Location oflnstallatlon ~a/~,~ <br /> <br />3. <br /> C0ntractor Iuformatlon <br /> <br /> (~o~. ~side ~, ~ ~ ~Me ~ the c~ple~d ~t~. ' <br /> ( ~w~ ~ my own gma~ cmtraet~. <br /> <br />with a contractor who is ~gistered withe Constmcrical C~nltractoes Board, rand will immediately notify Marion County of the name ~ the contractor. <br /> {~i ) I am a regist~red builder OR llle au t h o ri~ ~n~t~i~ ~ ~a tiv'e of a registered <br /> <br />Architect nme: [ MaillngAddresg: ' "l Phone: , <br />4, Fee Schedule <br /> <br />Valuation: $~. ~'~ <br /> <br />B, Miscellanerm$ Fees <br /> (I) Driveway w/curb @ $7,50 <br /> <br /> ~) D~veway w/o curb ~ $17.~ <br /> <br /> (3) Si~ <br /> <br /> (4) Addifio~M ~an Renews or Add~d~s <br /> <br /> (5) ~ves~ga6~ Fee <br /> <br /> (6) ~s~cfi~ Fee~ <br /> <br />I hereby certify that the above information is correct and that Ibave mad and understand thc Information Notice to Property Owners about Cons ruction Rosponsibilities on the <br />rev*rse side of this form. <br /> <br />MC 15-73 Rev. 11/91 <br /> <br /> <br />